Treatment of pseudoarticular scaphoid nonunion with bone graft and percutaneous fixation under wrist arthroscopy
10.3760/cma.j.cn115530-20190801-00264
- VernacularTitle:腕关节镜下植骨经皮内固定治疗假关节型舟骨骨折不愈合
- Author:
Weiya QI
1
;
Bo LIU
;
Hui ZHU
;
Dawei ZHENG
Author Information
1. 徐州仁慈医院手外科 221004
- From:
Chinese Journal of Orthopaedic Trauma
2020;22(8):730-732
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the treatment of pseudoarticular scaphoid nonunion with bone graft and percutaneous fixation under wrist arthroscopy.Methods:Six patients with pseudoarticular scaphoid nonunion were treated with arthroscopic debridement, bong grafting and percutaneous fixation between October 2015 and October 2018 at Department of Hand Surgery, Xuzhou Renci Hospital. They were 5 men and one woman with 4 left and 2 right sides affected, aged from 28 to 51 years (mean, 39.5 years). The sclerotic bone was erased under wrist arthroscopy. Percutaneous fixation started after autoallergic cancellous bone chips were implanted and impacted through a sleeve inserted via the medial carpal approach. For the nonunion with a pseudarthrosis connecting the midcarpal and radiocarpal joints, we put an inflated Foley catheter through a 3/4 portal underneath the proximal edge of the pseudarthrosis to block the possible leakage of the small cancellous bone chips. The wrist functions were evaluated at the final follow-up using the modified Mayo elbow performance score (MEPS); the flexion-extension motion and ulnar-radial deviation of the wrist were recorded.Results:The operation time for the 6 patients ranged from 2 to 4 hours (average, 3.2 hours); their follow-up duration ranged from 6 to 15 months (average, 11.3 months). All the patients obtained bony union after 8 to 14 weeks (average, 12.1 weeks). The flexion-extension motion of their affected wrist ranged from 75° to 135° (average, 107.0°), accounting for 85% of that of the healthy side; the ulnar-radial deviation of their affected wrist ranged from 40° to 80° (average, 51.5°), accounting for 88% of that of the healthy side. MEPS at the final follow-up revealed 4 excellent, one good and one fair cases.Conclusion:Arthroscopic bone grafting and percutaneous fixation is a reliable and effective minimally invasive treatment for pseudarthrotic scaphoid nonunions.
